Oley Mendy Hatibie, Oley Maximillian Christian, Kepel Billy Johnson, Faruk Muhammad, Wagiu Angelica Maurene Joicetine, Sukarno Irawan, Tulong Marcella Tirsa, Sukarno Vania
From the Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.
Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Kandou Hospital, Manado, Indonesia.
Plast Reconstr Surg Glob Open. 2024 Mar 25;12(3):e5692. doi: 10.1097/GOX.0000000000005692. eCollection 2024 Mar.
Diabetic foot ulcers (DFUs) are common complications of uncontrolled diabetes mellitus that can result in infection and amputation of the lower extremities. This study compared the benefits and risks of hyperbaric oxygen therapy with those of other DFU treatments, based on the Wagner grading system.
Systematic searches for randomly controlled trials using hyperbaric oxygen therapy for DFUs were performed using PubMed, the Cochrane Library, and Embase. Data regarding demographics, wound healing, minor and major amputations, operative debridement, nonhealing wounds, and adverse effects were analyzed based on Wagner grades, using RevMan 5.4.1 and Microsoft Excel.
Hyperbaric oxygen therapy was significantly superior to other treatments for wound healing rates 8 or more weeks after the final treatment (RR = 2.39; 1.87-3.05; < 0.00001) minor/distal amputations (RR = 0.58; 0.43-0.80; < 0.007), and major/proximal amputations (RR = 0.31; 0.18-0.52; < 0.00001) for the 14 studies analyzed. In addition, this therapy increased the rate of complete wound healing for Wagner grades II (RR = 21.11; 3.05-146.03; = 0.002), III (RR = 19.58; 2.82-135.94, = 0.003), and IV (RR = 17.53; 2.45-125.44; = 0.004); decreased the minor/distal amputation rate for grade III (RR = 0.06; 0.01-0.29; = 0.0004) and the major/proximal amputation rate on for grade IV (RR = 0.08; 0.03-0.25; < 0.0001); and decreased the operative debridement rate for Wagner grade II (RR = 0.09; 0.01-0.60; = 0.01).
Moderate-quality evidence revealed that adjunctive hyperbaric oxygen therapy improved DFU wound healing for Wagner grades II, III, and IV; prevented minor and major amputations for grades III and IV, respectively; and prevented operative debridement in grade II wounds.
糖尿病足溃疡（DFUs）是未控制的糖尿病常见并发症，可导致感染及下肢截肢。本研究基于瓦格纳分级系统，比较了高压氧治疗与其他DFU治疗方法的益处和风险。
使用PubMed、Cochrane图书馆和Embase对使用高压氧治疗DFUs的随机对照试验进行系统检索。使用RevMan 5.4.1和Microsoft Excel，根据瓦格纳分级对人口统计学、伤口愈合、小截肢和大截肢、手术清创、伤口不愈合及不良反应的数据进行分析。
对于分析的14项研究，在最终治疗8周或更长时间后，高压氧治疗在伤口愈合率方面显著优于其他治疗（RR = 2.39；1.87 - 3.05；P < 0.00001），在小/远端截肢方面（RR = 0.58；0.43 - 0.80；P < 0.007），以及在大/近端截肢方面（RR = 0.31；0.18 - 0.52；P < 0.00001）。此外，该疗法提高了瓦格纳II级（RR = 21.11；3.05 - 146.03；P = 0.002）、III级（RR = 19.58；2.82 - 135.94；P = 0.003）和IV级（RR = 17.53；2.45 - 125.44；P = 0.004）伤口的完全愈合率；降低了III级的小/远端截肢率（RR = 0.06；0.01 - 0.29；P = 0.0004）和IV级的大/近端截肢率（RR = 0.08；0.03 - 0.25；P < 0.0001）；并降低了瓦格纳II级的手术清创率（RR = 0.09；0.01 - 0.60；P = 0.01）。
中等质量证据表明，辅助高压氧治疗可改善瓦格纳II级、III级和IV级DFU伤口愈合；分别预防III级和IV级的小截肢和大截肢；并预防II级伤口的手术清创。
